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Clinical Relevance of Splenic Hilar Lymph Node Dissection for Proximal Gastric Cancer: A Propensity Score-Matching Case-Control Study

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The application of splenic hilar lymph node (no. 10 LN) dissection (no. 10 LND) for proximal gastric cancer (PGC) remains controversial. This study aimed to investigate the clinical relevance of no. 10 LND from the perspective of long-term survival.

Methods

The main study population included 995 previously untreated patients who underwent laparoscopic radical total gastrectomy between January 2008 and December 2014. Of these 995 patients, 564 underwent no. 10 LND (no. 10D+ group) and the remaining 431 patients did not (no. 10D– group). Propensity score-matching was applied to reduce the effects of confounding factors. The study end points were overall survival (OS) and disease-free survival (DFS). Additionally, 39 patients who received neoadjuvant chemotherapy during the same period also were included as a separate population for analysis.

Results

The metastasis rate for no. 10 LN was 10.5 % (59/564). No significant differences were observed in intra- and postoperative complications nor in mortality between the no. 10D+ and no. 10D– groups (all P > 0.05). After 1:1 matching, the two groups were comparable in clinicopathologic characteristics. The no. 10D+ group had significantly better survival than the no. 10D– group (5-year OS: 63.3 % vs 52.2 %, P = 0.003; 5-year DFS: 60.4 % vs 48.1 %, P = 0.013). For the patients who received neoadjuvant chemotherapy, the 5-year OS rates in the no. 10D+ and no. 10D– groups were respectively 50.6 % and 31.3 % (P = 0.150) and the 5-year DFS rates were respectively 51.5 % and 31.3 % (P = 0.123).

Conclusions

Patients with untreated PGC may achieve the benefit of long-term survival from no. 10 LND. For patients with PGC who undergo neoadjuvant chemotherapy, no. 10 LND may not bring survival benefits. However, further validation with a large-sample study is needed.

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Acknowledgment

This study was supported by Scientific and Technological Innovation Joint Capital Projects of Fujian Province (2017Y9011, 2017Y9004, 2018Y9041), the Construction Project of Fujian Province Minimally Invasive Medical Center (No. [2017]171), the second batch of special support funds for Fujian Province innovation and entrepreneurship talents (2016B013), the Special Fund for Clinical Research of Wu Jieping Medical Foundation (No: 320.6750.17511), and the general project of sailing fund of Fujian Medical University (2017XQ1026). The authors are express their gratitude to the patients and their families for their support in this study.

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Author notes

  1. Jian-Xian Lin and Zu-Kai Wang have contributed equally.

Authors and Affiliations

  1. Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China

    Jian-Xian Lin MD, PhD, Zu-Kai Wang MD, Ying-Qi Huang MD, Jian-Wei Xie MD, PhD, Jia-Bin Wang MD, PhD, Jun Lu MD, PhD, Qi-Yue Chen MD, PhD, Long-Long Cao MD, Mi Lin MD, Ru-Hong Tu MD, Ze-Ning Huang MD, Ju-Li Lin MD, Hua-Long Zheng MD, Chao-Hui Zheng MD, PhD, Chang-Ming Huang MD & Ping Li MD, PhD

  2. Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China

    Jian-Xian Lin MD, PhD, Zu-Kai Wang MD, Ying-Qi Huang MD, Jian-Wei Xie MD, PhD, Jia-Bin Wang MD, PhD, Jun Lu MD, PhD, Qi-Yue Chen MD, PhD, Long-Long Cao MD, Mi Lin MD, Ru-Hong Tu MD, Ze-Ning Huang MD, Ju-Li Lin MD, Hua-Long Zheng MD, Chao-Hui Zheng MD, PhD, Chang-Ming Huang MD & Ping Li MD, PhD

  3. Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China

    Jian-Xian Lin MD, PhD, Jian-Wei Xie MD, PhD, Jia-Bin Wang MD, PhD, Chao-Hui Zheng MD, PhD, Chang-Ming Huang MD & Ping Li MD, PhD

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  1. Jian-Xian Lin MD, PhD
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Contributions

Conceptualization, JXL, PL, ZKW; Data Curation, ZKW, HLZ, YQH; Formal Analysis, ZKW, ML, RHT; Funding acquisition, CMH, CHZ, JWX, PL; Investigation, ZNH, JLL; Methodology, JXL, PL, ZKW; Project administration, PL, CMH, CHZ; Software, ZKW, JL, QYC, LLC; Supervision, PL, CMH, CHZ; Validation, CMH, CHZ, JWX, JBW; Visualization, ZKW, YQH; Writing Original Draft Preparation, JXL, ZKW; Writing Review and Editing, PL, CMH, CHZ. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Chao-Hui Zheng MD, PhD, Chang-Ming Huang MD or Ping Li MD, PhD.

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Signed informed consent was obtained from all patients before surgery. The Ethics Committee of Fujian Medical University Union Hospital approved the study.

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Lin, JX., Wang, ZK., Huang, YQ. et al. Clinical Relevance of Splenic Hilar Lymph Node Dissection for Proximal Gastric Cancer: A Propensity Score-Matching Case-Control Study. Ann Surg Oncol 28, 6649–6662 (2021). https://doi.org/10.1245/s10434-021-09830-1

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